Intracranial aneurysms constitute a significant part of the caseload for any neurosurgical service. Despite the occurrence of intracranial aneurysms and the availability of advanced diagnostic tools and management options, there is a paucity of published data concerning aneurysm patterns in Kenya.

Background: Extradural hematomas are neurosurgical emergencies and are one of the most common causes of mortality and disability after traumatic brain injury. This study aimed at evaluating the current management and factors that influence outcome in patients treated for extradural hematoma in an African setting.

Methods: A total of 224 consecutive patients who were admitted to the neurosurgical unit at the Kenyatta National Hospital and diagnosed with extradural hematoma between January 2007 and December 2011 were included in this study.

Results: There was a male predominance of 96.9%. The median age was 29 years. The most common cause of injury was assault (45%). Good functional recovery was achieved by 190(86.2%) of the patients in our series, whereas residual disability accounted for 6.7% and mortality for 7.1%. The proportion of patients who achieved functional recovery significantly decreased with increasing age (p=0.011). A lower GCS score at
admission was associated with a poorer outcome (p=0.032). The time elapsed from initial trauma to surgery significantly influenced outcome (p=0.007).

Conclusion: A longer duration between trauma and decompression, a low preoperative GCS score, pupillary abnormalities and those older than age 61 are poor prognostic indicators.

Introduction: Surgical extirpation of pituitary lesions and can be performed by craniotomy or trans-sphenoidal approaches. This could be for pituitary ablation, excision of pituitary adenomas, craniopharyngiomas, suprasellar meningiomas and other types of tumors of the sellar region. Despite this being a common neurosurgical procedure there is a paucity of data on the local Kenyan experience and outcomes following pituitary surgery. Study Design and Site: A retrospective study at the Kenyatta National Teaching and Referral Hospital, Nairobi. Objectives: To evaluate the clinical presentation, management and outcome of patients undergoing surgery for pituitary lesions at the Kenyatta National Hospital. Patients and Methods: Following ethical approval, patients’ records were retrieved and assessed for clinical and radiologic features of pituitary lesions, surgical treatment and post operative outcome. All the data was coded and analysed using Statistical Package for Social Sciences (SPSS) version 16.0. Frequencies and means were computed for description of the various variables and the association between categorical variables calculated using Chi-square test while comparison of mean values was performed using the one-way analysis of variance test (ANOVA). Results: A total of 65 patients were included with 39 (60%) female and 26 (40%) male patients. The mean age was 36.88 years (+ 14.689) and majority of the patients (55%) were aged between 26 and 45 years. The most common presentation were visual disturbances reported by 57 (87.7%) of the patients having reduction in visual acuity, while 37 (56.9%) had bitemporal hemianopia. Amenorrhea and primary infertility were reported by 11 (16.9%) patients while 14 (21.5%) and 8 (12.3%) had galactorrhea and gynecomastia respectively. Ten patients (15.4%) had acromegalic features of hypergnathia and acral enlargement of hands and feet. Sixty two (95.4%) patients were operated during the study period and of these 28 (45.2%) by the transphenoidal approach as opposed to 34 (54.85%) by craniotomy. The pterional trans-sylvian approach was the most common of the transcranial hypohysectomies accounting for 17 (50%) patients, while 15 patients (44.1%) were operated by the subfrontal approach and two patients were operated via midline inter-hemispheric approach.2nd Bi-ennual International Scientific Conference 2013, Nairobi Kenya 29 Majority (96.4%) of trans-sphenoidal hypophysectomies were by sub-labial incision. Fifty (76.9%) of the patients had good functional outcome while 11 (16.9%) and 4 (6.2%) suffered moderate and severe disability respectively. Patients’ age (p=0.0029), duration of symptoms prior to surgery (p=0.0018) and surgical management versus conservative (p=0.001) significantly affected patient outcome. There was no statistically significant difference in outcome between patients of different sex (p=0.058) or the type of operation performed (p=0.191). Conclusion: Transsphenoidal and trans-cranial approaches are effective and safe treatment strategies for pituitary lesions with low morbidity, mortality and recurrence rates. With the paradigm shift towards more trans-sphenoidal and particularly endonasal approaches, additional prospective studies are required to assess clinical and endocrinological outcomes.

This is a case report of an 18 year old man with craniofacial fibro-osteo-dysplastic lesion which exhibited both exophytic and endophytic growth patterns. We discuss the extent of tumour growth and its associated secondary changes.

Background: Subarachnoid Haemorrhage (SAH) has been shown to have a global incidence of 2-49 cases per 100 000 population, and it is associated with a high morbidity and mortality. There is a scarcity of data regarding this condition in Kenya. This paper presents the causes and risk factors for this condition in patients presenting to our hospital.
Methods: This descriptive cross sectional study was conducted in Kenyatta National Hospital in Kenya. All patients admitted between December 2010 and March 2011 with a diagnosis of SAH, were included in the study. A total of 55 patients with SAH were recruited in the study.
Results: Slightly more females suffered from SAH than men, with a male: female ratio of 1: 1.1. The mean age was 47.6 years with a modal age group being 41-50 years. Intracranial aneurysms were seen in 29% of patients, the commonest location being in the anterior communicating artery (31%). Arterio-venous malformations were seen in 4% of patients. 51% of the patients had poorly controlled hypertension. Other risk factors included alcohol intake (31%), cigarette smoking (15%), and use of hormonal contraceptives was reported in 22% female study subjects.
Conclusion: In our population, the commonest cause of spontaneous SAH is aneurysmal bleeds mainly in the anterior circulation. Further, most of the risks involved in causation of SAH are modifiable therefore interventions such as proper blood pressure control should be put in place so as to reduce the burden of this disease.

Head injury is a critical public health problem responsible for up to 50% of fatalities among trauma patients and for a large component of continuing care among survivors. Intracranial hematomas are among the most common clinical entities encountered by any neurosurgical service and have a very high mortality rate and extremely poor prognosis among traumatic brain injuries. The purpose of this study was to investigate reliable factors influencing the functional outcome of the patients with traumatic intracranial hematomas (ICHs). A retrospective analysis was conducted of consecutive patients presenting at the Kenyatta National Hospital between January 2000 and December 2009. Following ethical approval, the records of patients admitted to the neurosurgical unit and diagnosed with traumatic ICH were retrieved and reviewed. The outcome measure was the Glasgow Outcome Scale (GOS) score at discharge. Data were collected in preformed questionnaires, and the coding and analysis were carried out using SPSS, version 11.5. Of the 608 patients diagnosed with intracranial hematomas during the study period, there was a clear male predominance, with 89.3% male and 10.7% female patients. Majority of the patients (49%) were aged between 26 and 45 years, whereas 5.6% and 9.4% were younger than age 13 years and older than age 61 years, respectively. The most common cause of injury was assault (48%). Good functional recovery was achieved by 280 (46.1%) of the patients in our series, whereas moderate and severe disability accounted for 27% and 6.9%, respectively. Males were more likely to have functional recovery (46.4%) than were females (43.1%), though this finding was not statistically significant (P = 0.069). The proportion of patients who achieved functional recovery seemed to decrease with increasing age. Patients who were involved in motor vehicle accidents were less likely to have functional recovery (33.7%, P = 0.003) than those who fell (53.6%). There was a statistically significant difference in the proportion of patients who achieved functional recovery, with 65.2% of those who had mild head injury as compared to 46% and 15.1% (P ≤ 0.001) for those with moderate and severe head injury, respectively. Patients who had surgical intervention were more likely to achieve functional outcome (51.2%) as compared to 31.7% in those managed conservatively. Furthermore, the time elapsed from initial trauma to surgery significantly influenced outcome. The type of surgery done was not found to significantly influence patient outcome (P = 0.095). An increased risk of poor outcome occurs in patients who are older than age 61 years, have lower preoperative GCS scores, pupillary abnormalities, and a long interval between trauma and decompression. The findings would help clinicians determine management criteria and improve survival.

Head injury is a critical public health problem responsible for up to 50% of fatalities among trauma patients and for a large component of continuing care among survivors. Intracranial hematomas are among the most common clinical entities encountered by any neurosurgical service and have a very high mortality rate and extremely poor prognosis among traumatic brain injuries.

To describe injuries and outcomes among children who fall from a height Design: Prospective, convenience hospital based study. Setting: Paediatric surgical wards of Kenyatta National Hospital, Nairobi, from November 2006 to February 2007. Subjects: Children aged 1-13 years who sustained injuries after failing from any height. Results: Eighty children were recruited. There were 61 male (76%) and 19 female (24%), with an age range 1-13 years. Most injuries occurred at home (78.75%) after falling from buildings (33.75%), and were of mild-to-moderate severity. 13.4% sustained external haemorrhage, 16.5% sustained facial injuries, 25.2% sustained CNS injuries, 43.3% sustained various fractures, and 1.6% sustained abdominal trauma. The head and musculoskeletal systems were the most likely regions to be injured. The most common diagnoses were supracondylar fracture of humerus and mild head injury. No thoracic or pelvic fractures were recorded. Recovery was good in most instances. Conclusion: Most children who sustain injuries after a fall from height do so after falling from a building. The most common types of injuries sustained were to the head and distal limbs, especially fractures. They were mostly of mild-moderate severity and recovery usually complete.

Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and neurosurgical management of VEDH.

To determine the presentation and management of patients with pressure ulcers. Design: A prospective study. Setting: The Kenyatta National Hospital (KNH) and National Spinal Injury Hospital (NSIH). Subjects: One hundred and thirteen patients were evaluated. Ninety six patients from KNH and seventeen from NSIH. Patients admitted at Kenyatta National Hospital and National Spinal Injury Hospital with pressure ulcers during the study period. Results: Of the 113 patients, 77 (68.1%) were male and 36 (31.9%) were female. Mean age of the patients studied was 38.1 years while the range was between 12 and 74 years. Paraplegia was the main associated medical condition accounting for 35.4%, followed by HIV/AIDS with 27.4%. The most common anatomical site for pressure ulcers was tronchanteric region with 43% of the ulcers. Pressure ulcers of grade III and IV accounted for 66.4% of the ulcers. Two hourly turning was the most common method of pressure dispersion used. Gauze dressing was the most common method used in wound care while 67.3% of the patients had their wounds cleaned with povidoneiodine. Fasciocutaneous flaps were the most common surgical procedure performed (81.7%) for closure of pressure ulcers. Overall, 59.3% of surgical procedures had been successful at one month. This was, however, reduced to 48.1% at three months. Conclusion: Majority of patients with pressure ulcers were in a relatively young age group with a mean age of 38 years. Most of the ulcers were located along bony prominence points of the pelvic girdle and the proximal femur. Most of the ulcers in this study were treated conservatively, with only a few ulcers subjected to surgical interventions. For the ulcers treated with surgical interventions the early outcome was good, however studies need to be done to determine long term outcomes.

Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and neurosurgical management of VEDH.

OBJECTIVE: To study the factors influencing the outcome of severe head injury. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Six hundred and seventy seven patients with severe head injuries who were seen at Kenyatta National Hospital between January 1992 and December 1996. RESULTS: Six hundred and seventy seven patients with severe head injuries were treated at Kenyatta National Hospital, between January 1992 and December 1996. Three hundred and eighty one patients died while undergoing treatment, 56.2% overall mortality. Age specific mortality was 35.7% in patients below 13 years, 44% in age group 14-25 years, 56% in age group 26-45 years. The admission Glasgow coma scale (GCS) was recorded in 637 patients. Patients with admission GCS of 3-4 had a mortality of 88%, those with GCS 5-6 had a mortality of 60% and those with admission GCS 7-8 had a mortality of 52%. Ninety per cent of the patients who had bilaterally dilated pupils not reacting to light on admission died and 66% of the patients with bilaterally constricted pupils at the time of admission died. Only 20% of patients with severe head injury who had normal pupillary reaction to light at the time of admission died. Eighty five per cent of the patients with systolic BP of less than 90 mmHg on admission died while 60% of those with systolic BP greater than 120 mmHg died. CONCLUSION: In this study, factors associated with poor outcome in severe head injury patients at Kenyatta National Hospital were age, admission GCS, admission blood pressure (systolic), presence of other associated injuries and pupillary reaction to light.